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The Four Processes of Motivational Interviewing: Spotlight on Evoking

April 24, 2016
Clinical Education, Motivational Interviewing
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Garden tools and watering can with grass

Evoke change talk to enhance motivation for change

 

Previously, we looked at Motivational Interviewing (MI) as having four key processes and reviewed practice exercises targeting the first two processes:  engaging and focusing. This week’s intentional practice centers on evoking, specifically on evoking change talk.

Once we have engaged with our client and have collaboratively identified a goal (focusing), ambivalence about change is still common. Increased client change talk is associated with increased likelihood for change. Evoking change talk is key. When ambivalence is present, it is normal for change talk to occur within the context of sustain talk. This activity will help you practice selectively reflecting the change talk content contained within ambivalence.

 

Instructions: Review the client statements below, containing both change talk and sustain talk, and develop reflective statements that are focused on the change talk.  

Here’s a pre-test to get you started:

Client statement:

“I am 78 years old, and this medication is ruining what life and pleasure I have left. I know the doctor said there is a good chance it will help things, but I just don’t think these side effects are worth it.”

Sample therapist responses: Which reflective response focuses on the change talk in the above statement?

a. You really don’t want to continue with this medication.

b. It’s pretty clear that the doctor wants you to continue.

c. You’re not sure whether it’s worthwhile to continue the medication.

(check out the end of this article for the correct answer)

 

Note: The point of this exercise is not to do a double-sided reflection, but rather to listen for and select the change talk, and make that your focus in your reflective statement.

Client Statement: Start out by underlining the change talk in the statements below

 

 Reflection: Now write down a reflection that selectively responds only to the client change talk contained in the statement
1.      The material the clinic gave me for my high blood pressure said I should avoid processed food, or else read the labels. I’m so busy I barely have time to eat, let alone shop, analyze my groceries, and spend half the night in the kitchen. These people do not live in the real world.

 

  
2.      Is it such a crime that I want to enjoy life while I’m still young? Once I’m tied into work, paying the bills, kids and all that I can scale things back.

 

  
3.      It is so frustrating that the minute you get pregnant everyone expects you to be perfect! I am so stressed out, it can’t be good for the baby. I am only having a few cigarettes a day, and my partner is totally on my case about it.

 

  

Reflective practice questions:

  1. How easy or difficult was it for you to identify the change talk in each of the client statements?
  2. How easy or difficult was it for you to frame a complex reflection that would further evoke change talk?
  3. What are the implications of this for your own continued growth and practice as a Motivational Interviewing practitioner?

(Correct answer: b. It’s pretty clear that the doctor wants you to continue.)

Adapted from: MINT TNT Manual (2014), various authors. 

The Four Processes of Motivational Inteviewing: Spotlight on Focusing

April 10, 2016
Motivational Interviewing
2 Comments

camera lens

 

Focusing means strategic centering with a collaborative goal

 

In a previous article, we looked at Motivational Interviewing (MI) as having four key processes: Engaging, Focusing, Evoking and Planning.

Motivational Interviewing is directional – not directive. There is a horizon, something that we and the client are committed to working toward. However, finding and collaboratively agreeing on goals can be a challenge! This week’s intentional practice looks at the process of working with your client to jointly identify an agreed-upon goal. Below are two brief case scenarios. With a partner, you will each take a turn with one of the scenarios as a departure point for a follow-up session with a client with the intention of setting an agenda for change. The skills for intentional practice in this activity are to:

Practice a focusing conversation using the skills of MI – with special attention to those noted above. How can you practice these skills to guide the client toward focusing on a meaningful and collaborative goal? Take five minutes and then switch roles. After you have both had an opportunity to practice, take five minutes to debrief and share feedback with your learning buddy.

 

Case Example 1:

You are meeting with your client, Akilesh, for a follow-up appointment. In your initial session, you learned that he has been under a great deal of stress due to impending lay-offs at his work place. To make matters worse, his wife is in her first month of maternity leave with a reduced income. His mother’s health is failing, and his older son has been acting out at school: hitting and spitting at other children in his class, and on one occasion, his teacher. Finally, at the end of your first session, Akilesh “came clean” with you and acknowledged that he smokes 10-15 cigarettes per day.

 

Case Example 2:

You are meeting with your client, Elina, for a follow-up appointment. At the end of your initial session, Elina reluctantly agreed to come back and see you again. You suspect that in addition to appeasing her cardiologist by attending the referral appointment with you last time, she is now coming back for this second appointment because she wants to appease you. In the previous session, Elina acknowledged that she would probably be healthier if she quit smoking, but stated that smoking is a profound pleasure for her. She shared that she has already made so many changes, she just can’t see herself giving up her cigarettes.

 

Reflective practice questions:

Was your “righting reflex” triggered by anything in the case example, or by any of the client responses in your role play? To what extent were you able to maintain MI Spirit throughout the conversation?